Active NPI
Jeffrey Martin, LCSW
- Professional Counselor
- Rockford, IL
National Provider Identifier
1710145743
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 149003373
- Practice address
- 5804 Elaine Dr
Rockford, IL 61108-2435 - Phone
- (815) 397-7654
- Fax
- (815) 397-2712
- NPI assigned
- May 27, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 149003373 | IL | Primary |
Addresses
Primary practice location
5804 Elaine Dr
Rockford, IL 61108-2435
Mailing address
5804 Elaine Dr
Rockford, IL 61108-2435
Phone (815) 397-7654
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149003373 | IL | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mathers Clinic, LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Child & Adolescent Psychiatry Physician
- Rockford, IL
- NPI 1215194519
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211846400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211846400000",
"number": "1710145743",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5804 ELAINE DR",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082435",
"telephone_number": "815-397-7654",
"fax_number": "815-397-2712"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5804 ELAINE DR",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611082435",
"telephone_number": "815-397-7654",
"fax_number": "815-397-2712"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JEFFREY",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-27",
"last_updated": "2008-05-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "IL",
"license": "149003373",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.